Infantile hemangiomas, the most common tumors of infancy, are vascular tumors characterized by rapid proliferation of endothelial cells during the first few months of postnatal life followed by slow spontaneous involution. Most disappear spontaneously (immature hemangiomas), while others persist and create cosmetic problems. Complications may follow overtreatment, posttraumatic ulceration, or localized tissue hypertrophy from a persistent angioma of the CNS, the face or an extremity.
While many hemangiomas eventually “involute,” the result is not always cosmetically acceptable. Early intervention has been shown to reduce the need for corrective surgery after “involution” has occurred, or to, at least, minimize extensive corrective surgeries in the future. Psycho-social scarring which occurs when a child has been forced to live with a facial deformity until “involution” has been completed can be avoided by early, aggressive intervention, according to presently known treatment options.
Conventional treatment options for hemangiomas range from surgical excision (followed, in cases of facial or neck hemangiomas, with cosmetic surgery) to systemic corticosteroid treatments, laser, and use of alpha-interferon. Recently, cryosurgery and sclerotherapy, have been proposed additions to the available treatment regimens for hemangiomas.
Each conventional treatment option carries potential side effects. Clearly, surgery always presents risks, whether for infection, unexpected patient reaction to anesthesia, and/or unexpected aesthetic results.
While systemic corticosteroid treatment is suspected of certain side effects, regardless of age, steroid treatment carries decided risks if carried on beyond a child's first birthday. Furthermore, hemangiomas do not warrant nor benefit from steroids beyond the first birthday, in part, because proliferation of hemangiomas tends to end by that point anyway. In any event, if steroids are lowered too quickly or given intermittently, “rebound growth” is possible, if not likely. Some investigators have reported other side effects from steroid treatments. In one investigation, children (29 percent) became more irritable, depressed and/or napped less during treatment, although this resolved as treatment was tapered and discontinued. Other short-term side effects included gastric irritation, oral or perineal yeast infection, recurrent otitis media, hypertension, and myopathy.
As stated above, another treatment is sclerotherapy (i.e., injection of a chemical irritant into a vein to “harden” it). The disadvantages of sclerotheraphy include the pain of injection, swelling, and psychological strain associated therewith, as well as the danger of necrosis if the sclerosis technique is flawed.
While certain treatments for hemangiomas are considered typically effective, the psychological effects of hemangiomas alone warrant continued pursuit of more effective treatment regimens for hemangiomas, whether for use alone, or in concert with existing treatment options. Also, because most patients receiving treatments are infants or small children, patient tolerance for the treatment options becomes of more paramount importance.